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Terefe B, Assimamaw NT, Chekole B. Individual and community level factors of safe child feces disposal among youngest children in East Africa: a multilevel modeling analysis using recent national demography and health survey data. Arch Public Health 2024; 82:109. [PMID: 39026362 PMCID: PMC11256366 DOI: 10.1186/s13690-024-01335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/29/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The Joint Monitoring Program (JMP) for water supply and sanitation developed by the WHO and UNICEF defines safe child feces disposal practices as either burial or defecation into a toilet. Children become exposed to fecal-oral illnesses when their stools are not disposed of appropriately, and this vulnerability persists until all children's stools are properly disposed of. Data on the elements influencing child feces disposal in East Africa is scarce. Hence, this study aimed to assess the prevalence and associated factors of safe child feces disposal in East Africa. METHODS Data from the Demographic and Health Surveys, which were collected between 2015 and 2022 in 10 East African nations, were used in this analysis. For a weighted 44,821 children under the age of two, we examined additional features as well as how child feces were disposed of. Both bivariable and multivariable multilevel logistic regression were carried out to choose potential components and identify important explanatory variables connected to the outcome variable. With 95% confidence intervals, adjusted odd ratios (AORs) were used to present the results. P values of ≤ 0.2 and < 0.05 were used to investigate significant factors in the binary and multivariable multilevel logistic regression models respectively. RESULTS Approximately 65.54% (95% CI: 65.10, 65.98) of children's waste was disposed of properly. Women age from 35 to 49 years (AOR = 1.12, 95% CI: 1.05-1.19) 15-24 years old, primary (AOR = 1.62, 95% CI, 1.53,1.72), and secondary/higher education (AOR = 1.22, 95% CI, 1.14,1.31), women from highly educated community (AOR = 1.33, 95% CI, 1.22,1.46), employed (AOR = 1.29, 95% CI, 1.24,1.35), poorer(AOR = 1.51,95% CI, 1.42,1.61), middle(AOR = 1.67, 95% CI, 1.56,1.78), richer(AOR = 1.96,95% CI, 1.82,2.11), and richest(AOR = 2.08, 95% CI, 1.91,2.27), mass media exposure (AOR = 1.37,95% CI,1.31,1.44), community level mass media exposure (AOR = 1.23, 95% CI, 1.34,1.34), had ANC visit(AOR = 1.71, 95% CI, 1.55,1.88), modern contraceptive(AOR = 1.17, 95% CI, 1.12,1.23), health institution delivery (AOR = 2.22, 95% CI, 2.09,2.34), had an improved toilet facility (AOR = 1.12, 95% CI, 1.07,1.17), children who's their age group from 6 to 11 months old, (AOR = 2.12, 95% CI, 2.01,2.25) and 12-23 months old (AOR = 3.10,95% CI, 2.94,3.27) were the factors associated with higher odds of safe child feces disposal as compared to less than six months old children respectively. Finally, women from high community poverty level (AOR = 0.87, 95% CI, 0.79,0.95), and rural women were the factors associated with lower odds of safe child feces disposal (AOR = 0.91, 95% CI 0.85-0.98) compared to their counterparts respectively. CONCLUSIONS East Africa has a Slightly lower proportion of properly disposing of child feces. There was a strong correlation between characteristics such as residence, mother's age, education level, work status, place of delivery, ANC visit, child's age, wealth index, media exposure, and poverty. Acting on these factors and strengthening and using links between mother and child health care is, thus, strongly advocated.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Nega Tezera Assimamaw
- Department of Pediatric and Child Health, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bogale Chekole
- Department of Comprehensive Nursing, College of Medicine and Health Sciences, Wolkite University, Southern, Ethiopia
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Soboksa NE, Olkeba BK, Aregu MB. Does owning improved latrine facilities enhance the safe disposal of child feces in Africa? a systematic review and meta-analysis. PLoS One 2024; 19:e0303754. [PMID: 38753650 PMCID: PMC11098413 DOI: 10.1371/journal.pone.0303754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Improved sanitation refers to those that effectively avoid human contact with excreta in a hygienic manner. Having improved latrines is a key factor in adopting safe ways of disposing of child feces. However, previous studies in Africa that examined how owning improved latrine facilities associated with household child feces disposal practices has shown inconsistent results, and no systematic review of these findings has been done. Therefore, this study aims to synthesize the evidence on the significance of households having improved latrine facilities for safe child feces disposal practices among households with under five-year-old children in Africa. METHODS The searched databases include: PubMed/Medline, Ovid/Embase, ScienceDirect, AJOL and the Cochrane Library. In the search process, Google Scholar and references of other studies were considered. This review included studies that were published in English without any time restrictions. The outcome of this study was an estimate of the association between the ownership of an improved latrine and the disposal practices of children's feces. Two reviewers used the Excel data extraction tool to extract the relevant data from the studies that were included in the review. Using Stata version 16, a meta-analysis was performed with a random effects statistical model. The inverse index of variance (I2) was used to assess heterogeneity. Forest plots were used to show the pooled estimate with a 95% confidence interval. Publication bias was assessed using Egger's test and a funnel plot. RESULTS Out of the 616 studies that were retrieved, 15 were included in the systematic review analysis and 10 were included in the meta-analysis. All studies that were included are cross-sectional studies done in Ethiopia, Nigeria, Gambia, Malawi, Eswatini, Ghana, Zambia, and a study used data from sub-Saharan Africa. Improved latrine facilities significantly enhanced the practice of safe child feces disposal, as shown by the overall effect size (OR = 2.74; 95% CI = 1.24-1.35, I2 = 99.95%). In the subgroup analysis by sample size, the presence of improved latrines significantly enhanced safe child feces disposal in studies with sample sizes less than 1000 (OR = 3.24; 95% CI = 2.86-3.62, I2 = 61.38%), while there was no significant difference in studies with sample sizes greater than 1000 (OR = 2.67; 95% CI = 0.69-4.64, I2 = 99.97%). However, studies that involved children under 5 years old indicated that improved latrine facilities significantly enhanced the practice of safe child feces disposal (OR = 4.02; 95% CI = 2.03-6.09; I2 = 99.96%). CONCLUSIONS In this research study, we examined the ownership of improved latrine facilities among households with five-year-old children to enhance the disposal of child feces in a safer manner in Africa. The high heterogeneity among the studies and the cross-sectional design of the included studies limit the causal inference and generalizability of the findings. Therefore, meta-analyses of longitudinal and experimental studies are needed to confirm the causal relationship between improved latrine facilities and safe child feces disposal practices in Africa.
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Affiliation(s)
- Negasa Eshete Soboksa
- Department of Environmental Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Beekam Kebede Olkeba
- Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mekonnen Birhanie Aregu
- Department of Environmental Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh. J Epidemiol Glob Health 2024:10.1007/s44197-024-00210-y. [PMID: 38507184 DOI: 10.1007/s44197-024-00210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea. METHODS We conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator. RESULTS The intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways. DISCUSSION The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.
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Affiliation(s)
- Jesse D Contreras
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48103, USA
| | - Mahfuza Islam
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Jade Benjamin-Chung
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, 94304, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Mahbubur Rahman
- Environmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, 94305, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695, USA.
- Jordan Hall Addition 2225, Raleigh, NC, 27606, USA.
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Roy A, Rahaman M, Chouhan P. Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data. Sci Rep 2024; 14:6632. [PMID: 38503836 PMCID: PMC10950857 DOI: 10.1038/s41598-024-56715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024] Open
Abstract
A significant rural-urban disparity in unsafe child stool disposal practices exists in India, yet existing research falls short in identifying the contributing factors to this gap. This study addresses the research gap by contextualizing the rural-urban divide in unsafe child stool disposal using data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21). In particular, the study examines the prevalence and predictors of unsafe disposal practices, exploring associated contributing factors to this gap. The study involves a sample of 78,074 women aged 15-49 with a living child under 2 years, without any missing data related to the study interest. Employing descriptive statistics, the Pearson chi-square test, multilevel logistic regression, and the Fairlie decomposition model, the research aims to fulfill its objectives. The rural-urban gap in unsafe child stool disposal practices among the study participants was 22.3 percentage points (pp), with a more pronounced gap among the Scheduled Tribes (ST). Notably, the gap was particularly wide in Madhya Pradesh (33.9 pp), Telangana (27.5 pp), Gujarat (26.1 pp), and Rajasthan (25.8 pp). Predictors such as mother's education, mass media exposure, household wealth quintile, and sanitation facilities proved significant irrespective of residence. However, religion, social group, and water facility on household premises emerged as significant factors in rural areas only. The study identified that 67% of the explained gap in unsafe child stool disposal practices was attributed to the rural-urban difference in household wealth. Other noteworthy contributors were 'household sanitation facility' (21.3%), 'mother's education level' (3.9%), and 'water facility on household premises' (3.9%). These findings underscore the need for population and area-specific policy interventions, especially for individuals from socio-economically disadvantaged backgrounds, those with lower education levels, and limited exposure to mass media, particularly in states with a high prevalence of unsafe disposal practices. Such interventions are crucial to mitigating the existing rural-urban gap in unsafe child stool disposal practices.
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Affiliation(s)
- Avijit Roy
- Department of Geography, State Aided College Teacher, Malda College, Malda, West Bengal, 732101, India
| | - Margubur Rahaman
- Doctoral Fellow, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
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Rahaman M, Roy A, Chouhan P, Rana MJ. Exploring drivers of unsafe disposal of child stool in India using hierarchical regression model. PLoS One 2024; 19:e0295788. [PMID: 38498574 PMCID: PMC10947681 DOI: 10.1371/journal.pone.0295788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/29/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Disposal of children's stools is often neglected in Indian sanitation programs, putting them at higher risk of diseases transmitted through the fecal-oral route. Therefore, the current study aims to identify the socioeconomic and demographic factors associated with the unsafe disposal of child stool in India and to estimate the geographical variation in unsafe disposal. METHODS The study used 78,074 births under two years from the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis with the chi-square test, and a four-level hierarchical logistic regression model were applied to accomplish the study objectives. RESULTS Findings revealed a 61.3% prevalence of unsafe stool disposal nationwide, significantly varying between rural (45%) and urban (67%) areas. Multilevel logistic regression highlighted that mother's education, wealth quintile, and sanitation facility were significant predictors of unsafe disposal of child stools. Random intercept statistics revealed a substantial geographical unit-level variance in unsafe stool practice in India. CONCLUSION The study emphasizes the widespread unsafe disposal of child stool among Indian mothers with young children below two years, and the study underscores a range of contributing factors, including education, media exposure, prosperity, water availability, and sanitation. It also accentuates the significance of the geographical variance in the unsafe disposal of child stool in India, particularly at the household level, followed by the community level. Hence, the findings underscore the importance of focused interventions, including targeted household-level poverty alleviation programs, initiatives to enhance sanitation and water facilities, and community-level public health awareness programs.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Deonar, Mumbai, India
| | - Avijit Roy
- Department of Geography, Malda College, State Aided College Teacher, Malda, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Md. Juel Rana
- Govind Ballabh Pant Social Science Institute (GBPSSI), Allahabad, India
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Agyekum MW, Nyieku FE, Yeboah SB, Frempong-Ainguah F. Factors associated with rural-urban safe disposal of children stools in Ghana. BMC Res Notes 2024; 17:54. [PMID: 38378638 PMCID: PMC10880296 DOI: 10.1186/s13104-024-06701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION The burden of children's disease in many low-and middle-income countries is associated with poor sanitation, including unsafe disposal of children's stool. Infants and toddler stools pose a greater public health risk than adults. Studies on stool disposal in Sub-Saharan Africa (SSA) and Ghana have focused on prevalence, patterns, and associated factors. Nevertheless, these studies have not focused on factors that independently influence rural and/or urban child stool disposal. This study, therefore, examines factors associated with safe child stool disposal in rural areas separately from urban areas towards Ghana's readiness for ending open defaecation by 2030. METHODOLOGY We examined young children's faecal disposal drawing on the sixth round of the nationally-representative Ghana Multiple Indicator Cluster Survey (MICS) conducted in 2017/18. This study was restricted to children under two years, yielding a sub-sample of 3,476. Responses of caregivers or mothers who disposed of children less than two years faecal matter, their characteristics in addition to the child's age in months were analysed. A binary logistic regression was used to examine the factors associated with the safe disposal of young children's stools. RESULTS In the aggregated data, only 22% of households, regardless of their residence, dispose of their young children less than two years stools safely. From the disaggregated data, the rural analysis shows that 26% of young children's stools were safely disposed of, compared to 16% in the urban analysis. The urban analysis shows that the child's age, sex and caregiver's marital status were significantly associated with safe disposal of stools. On the other hand, child's age, caregiver listening to radio and household access to improved toilet facilities were significant in the rural analysis. CONCLUSION The safe practice of stool disposal was very low. The results of this study show that urgent and different policies and strategies are needed to address child stool disposal in urban residences compared to rural residences if we are to meet SDG targets of ending open defaecation.
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Affiliation(s)
- Martin Wiredu Agyekum
- Institute for Educational Research and Innovation Studies (IERIS), University of Education, Winneba, Ghana.
| | - Florence Esi Nyieku
- Department of Environmental Health and Sanitation Education, University of Education, Winneba, Ghana
| | - Sylvia Boamah Yeboah
- Faculty of Human and Social Studies, Mykolas Romeris University, Vilnius, Lithuania
| | - Faustina Frempong-Ainguah
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
- Ghana Statistical Service, Accra, Ghana
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Nazar SZA, Narayanappa C, Daniel D. Perception and Disposal Practices of Toddler Feces by Mothers in Suburban Area of Kendari, Indonesia. WHO South East Asia J Public Health 2024; 13:29-34. [PMID: 39167133 DOI: 10.4103/who-seajph.who-seajph_198_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/29/2024] [Indexed: 08/23/2024]
Abstract
Unsafe child feces disposal (CFD) is another form of open defecation and can pose a risk of disease in children. More than 30% of Indonesian households practice unsafe CFD, yet, its determinants are unknown. This study aims to identify the contextual and behavioral determinants of CFD through the lens of the Risk, Attitude, Norm, Ability, and Self-regulation (RANAS) framework. The cross-sectional study was conducted in 349 households in the suburbs of Kendari City, Southeast Sulawesi Province, Indonesia, in mid-2023. About 64% of the respondents practiced unsafe CFD. Most respondents used diapers that were immediately thrown into the trash without cleaning (i.e., 60.2%). Logistic regression analysis found two significant contextual factors associated with safe CFD: having received sanitation-related information and toddler age, i.e., children below 5 years old. Perceived severity was the most influential psychological factor behind the CFD practice, followed by knowledge. This study suggests that informing caregivers about the negative health effects of practicing unsafe CFD, especially on their children, can be a positive trigger for them to practice safe CFD. In addition, the promotion of early toilet initiation and recycling programs for used diaper waste should also be conducted to ensure comprehensive CFD management.
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Affiliation(s)
| | - Chandana Narayanappa
- Center for Emerging Technologies for Sustainable Development, Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - D Daniel
- Department of Health Behaviour Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
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Essuman MA, Storph RP, Ahinkorah BO, Budu E, Yaya S. Hygienic Disposal of Children's Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231204764. [PMID: 37899844 PMCID: PMC10605691 DOI: 10.1177/11786302231204764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results The overall prevalence of hygienic disposal of children's stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child's diarrhoea stool hygienically than their counterparts. Conclusion The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children's stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children's defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Kouassi HAA, Andrianisa HA, Traoré MB, Sossou SK, Momo Nguematio R, Ymélé SSS, Ahossouhe MS. Review of the slippage factors from open defecation-free (ODF) status towards open defecation (OD) after the Community-Led Total Sanitation (CLTS) approach implementation. Int J Hyg Environ Health 2023; 250:114160. [PMID: 36958189 DOI: 10.1016/j.ijheh.2023.114160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Open-defecation (OD) is one of the most widespread sanitation practices in low-income countries. This practice often causes diarrheal diseases and 760,000 deaths per year. To eradicate OD, several approaches have been developed, including Community-Led-Total Sanitation (CLTS) which is a participatory and community approach. The specificity of CLTS is that it is managed by the community itself, as its name implies, and that no subsidies or financial contributions from outside the community are used in the construction of the facilities. Although, the CLTS is effective in the short-term for eradicating OD, the long-term results are not encouraging: Open-Defecation-Free (ODF) communities revert to OD or partially use latrines. The present research is based on literature review and authors investigation in Burkina Faso. It was conducted to provide a comprehensive understanding of the factors that affect the sustainability of ODF-status leading to slippage in communities. It was found that these factors can be grouped into five categories: behavioral and social, technological, organizational, and vulnerability factors. The last one, socio-political factors, is a contribution from the authors as it was not reported in the literature yet. The authors have proposed graphical synthesis of all the slippage factors and their associated categories in the ODF-communities. Finally, authors have suggested that to sustain ODF-status of communities: include all stages of the sanitation value chain (SVC) in the CLTS, the follow-up activities after achieving ODF-status must be planned well in advance, sanitation marketing should be developed and the sanctions against the practice of OD have to be reinforced. Governments and donors should pay particular attention to the following options: raising awareness and regular monitoring after ODF certification, encouraging research on sustainable and pro-poor sanitation technologies, and building the capacity of implementing actors including facilitators. While obtaining ODF status is materialized by a sign with the status on it, this paper drew the attention of CLTS implementers to the lack of materialization of slippage when it occurs, and the absence of studies on the evolution of the community sanitation scale after ODF-status.
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Affiliation(s)
- Hemez Ange Aurélien Kouassi
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso.
| | - Harinaivo Anderson Andrianisa
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Maïmouna Bologo Traoré
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Seyram Kossi Sossou
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Rikyelle Momo Nguematio
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Sidesse Sonia Saapi Ymélé
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
| | - Mahugnon Samuel Ahossouhe
- Laboratoire Eau, Hydro-Systèmes et Agriculture (LEHSA), Institut International d'Ingénierie de l'Eau et de l'Environnement (2iE), 01 BP 594, Ouagadougou 01, Burkina Faso
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Sclar GD, Bauza V, Bisoyi A, Clasen TF, Mosler HJ. Contextual and psychosocial factors influencing caregiver safe disposal of child feces and child latrine training in rural Odisha, India. PLoS One 2022; 17:e0274069. [PMID: 36083872 PMCID: PMC9462565 DOI: 10.1371/journal.pone.0274069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
Child feces are an important source of fecal exposure in household environments. Typically, one of two behaviors is necessary to mitigate this risk: either caregivers dispose of their children's feces into a latrine or children learn how to use a latrine. Although past studies have examined factors associated with these two behaviors collectively (i.e. "safe disposal"), there is a need to separately analyze these distinctive practices to better inform programming. This study aims to quantitatively examine contextual and psychosocial factors influencing caregiver safe disposal and, separately, child latrine training. We surveyed 791 primary female caregivers, who reported on 906 children <5 years old, across 74 villages in rural Odisha, India. At their last defecation event, 38% of children used the latrine and another 10% had their feces safely disposed of into the latrine. Since caregiver safe disposal was rare, we instead assessed safe disposal intention. We used linear regression and multilevel mixed effects models to examine contextual and psychosocial factors. For contextual factors, we found caregivers had stronger safe disposal intention when they came from wealthier households and had greater informational support, but weaker intention when their latrine was near the household. Caregivers more intensely practiced latrine training with their child when they themselves used the latrine for defecation, the latrine was fully intact, and they had greater instrumental support. For psychosocial factors, caregivers had stronger safe disposal intention when their households expected them to practice safe disposal, they felt strongly committed to the behavior, and had a plan for what to do when faced with a water shortage. Caregivers more intensely taught their child how to use the latrine when they believed their child was at risk of becoming sick if they practiced open defecation (OD); viewed child OD as unbeneficial; liked teaching their child; personally felt it was important for the child's father to help; felt confident in their ability to teach their child; and had greater action control over their training practice. Interestingly, caregivers put less effort into latrine training when they felt more concerned for their child's safety when the child defecated outside. These findings underscore the critical need to separately assess unique child feces management (CFM) practices and also provide a road map for practitioners on the types of behavior change strategies to consider in their CFM programming.
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Affiliation(s)
- Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Thomas F. Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Global practices, geographic variation, and determinants of child feces disposal in 42 low- and middle-income countries: An analysis of standardized cross-sectional national surveys from 2016 - 2020. Int J Hyg Environ Health 2022; 245:114024. [PMID: 36029740 PMCID: PMC9489922 DOI: 10.1016/j.ijheh.2022.114024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022]
Abstract
Background Despite considerable progress improving water and sanitation access globally, unsafe child feces disposal remains common in many low- and middle-income countries (LMICs), posing an important health risk. The present study characterizes the current prevalence of child feces disposal practices and child latrine use across low- and middle-income countries and investigates determinants associated with appropriate disposal practices. Methods Data for children ranging from 0 through 4 years of age were analyzed from standardized and nationally-representative surveys of 42 LMICs collected from 2016 to 2020 to assess child feces disposal practices. We report child feces disposal in three categories: disposal in any type of latrine, disposal in an improved latrine, and disposal through means other than in a latrine. Survey weighted multiple Poisson regression models were used to explore factors associated with these practices. Results Data on 403,036 children (weighted N = 191 million) demonstrated that a minority (40.3%) of children have their feces disposed of in a latrine of any kind, and just 29% have feces disposed of in an improved latrine. Prevalence varied considerably by country and region. In adjusted analyses, both child feces disposal in any latrine and disposal in an improved latrine increased with child age, higher intra-country relative wealth, and urban living, and decreased with breastfeeding and shared sanitation facilities. Disposal in improved latrines additionally increased with access to higher levels of service for drinking water and higher mother's education. Nevertheless, the role of facility access alone was insufficient, as only about half of children with household access to any latrine or improved latrines had their feces disposed of in these facilities. Child latrine use among households with latrine access was also low and highly variable across countries. Conclusions Children's feces in LMICs are infrequently disposed of in any latrine type, and even less frequently in improved latrines. In order to minimize health risks in LMICs, increased effort must be undertaken not just to increase sanitation coverage but to address these common barriers to safe child feces disposal and child latrine use. Global child feces disposal in latrines is low and variable between countries. Latrine access is insufficient to explain low use for child feces management. Household relative wealth is associated with increased disposal in latrines. Child latrine use increases with age but remains low and varied between countries.
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Addis M, Worku W, Bogale L, Shimelash A, Tegegne E. Hygienic Child Feces Disposal Practice and Its Associated Factors among Mothers/Caregivers of Under Five Children in West Armachiho District, Northwest Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221114738. [PMID: 35910283 PMCID: PMC9335496 DOI: 10.1177/11786302221114738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children's feces are 5 times more dangerous than that of adults. Unhygienic disposal of child feces has been reported as one of the major sanitation problems in Sub-Saharan African countries. However, there is a scanty of information in the study area and evidences are insufficient in Ethiopia. Therefore, this study intends to assess child feces disposal practices and associated factors among Mothers/Caregivers of Under Five Children in West Armachiho District, Northwest Ethiopia. METHODS A community-based cross-sectional study was conducted in the West Armachho district from March 10, 2019 to April 10, 2019 by using a multistage cluster sampling method. Binary and multivariable logistic regression models were employed to identify factors associated to child faces disposal practice. The adjusted odds ratio with a 95% confidence interval and a P-value of ⩽.05 were used to declare statistical significance. RESULT The proportion of safe child feces disposal practice was 37.8% (95% CI: 34.6-40.89). Child feces disposal practice was significantly associated with the age of the child (AOR = 5.07, 95% CI: 2.52-10.21), the educational status of fathers (AOR = 2.34, 95% CI: 1.05-5.25), getting health education (AOR = 2.77, 95% CI: 1.84-4.16), utilization of basic type of latrine (AOR = 2.79, 95% CI: 1.55-5.02), knowledge of feces disposal technology options (AOR = 2.58, 95% CI: 1.88-3.96), and media exposure about child feces (AOR = 1.88, 95% CI: 1.22-2.99). CONCLUSION The practice of safe CFD was low. Age of the child, fathers' educational status, receiving health education, basic type of latrine, feces disposal technology options used, and media exposure were independent predictors of safe CFD practice. Interventions need to be designed targeting safe CFD practices taking into account different media outlets and advocacy of improved sanitation technology use by policy makers.
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Affiliation(s)
- Moges Addis
- Abirha Jira Health Office, West Armachiho District, Abirha Jira, Ethiopia
| | - Walelegn Worku
- Institutes of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Laekemariam Bogale
- Institutes of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Shimelash
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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